39例前置胎盘产前大出血患者的临床分析

目的探讨前置胎盘产前大出血的相关因素、妊娠结局与紧急处理措施。方法对1999年3月至2004年10月诊治的有产前大出血的39例前置胎盘患者进行回顾性分析。结果前置胎盘各类型间产前大出血总量、大出血发生孕周无差异(P>O.05);前壁胎盘与非前壁胎盘的大出血量无差异(P>0.05);产前出血1～2次者与>4次者比较,产前大出血量无差异(P>0.05);在末次出血2h内分娩者其产前大出血量明显多于2h以上者(P<0.05);出血次数大于4次者的新生儿体重明显轻于出血次数1～3次者。结论前置胎盘产前大出血量不能以胎盘类型、胎盘附着位置及产前出血次数来预测。     

重症脑血管疾病的脑电图改良分级标准研究

目的 比较脑电图(EEG)改良分级标准对脑血管疾病后脑功能损伤评价及预测预后的作用,为建立脑血管疾病的脑电图评估标准提供依据. 方法 对60例大脑半球病变的急性脑血管疾病患者进行EEG监测,并应用Synek标准和改良分级标准进行EEG分级分析.结果 两种标准的EEG分级与预后均有显著相关性(P<0.05),EEG级别越高,预后越差.经Logistic回归分析,改良标准生存、综合预测准确率更高,Synek标准低于改良标准.结论 应用改良标准进行的EEG分级能够较好地反映急性脑血管疾病后脑功能损伤的程度以及提高预测预后的准确性.     

The clinical role of combined serum C1q and hsCRP in predicting coronary artery disease

ObjectiveC1q has been shown to be associated with coronary heart disease (CAD) and can co-deposit with C-reactive protein (CRP) in atherosclerotic plaques. However, few studies have been conducted between C1q, CRP parameters and CAD. The aim of this study is to explore the relationship between C1q and CRP parameters and assess their clinical significance in CAD.Methods238 total patients who underwent coronary artery angiography were enrolled and divided into control group (n = 65), stable CAD group (n = 47) and unstable angina group (UA group, n = 126). Patients’ data were collected from self-administered questionnaires and electrical medical records. The severity of coronary stenosis was presented by Gensini score. The relationship between C1q, CRP parameters and CAD were evaluated by multivariate regression analysis and their predicting performance were assessed by ROC analysis and odds ratio analysis.ResultsCompared with control group, C1q was showed significantly lower in stable CAD (P = 0.004) and UA groups (P = 0.008), while hsCRP was higher in UA group (P = 0.024). Serum C1q was weakly positively associated with hsCRP (r = 0.24, P < 0.001) but not correlated with Gensini score. Logistic regression identified C1q (OR: 0.87 per 10 mg/L, 95% CI: 0.79–0.95, P = 0.001) and hsCRP (OR: 1.08 mg/L, 95% CI: 1.01–1.15, P = 0.032) as independent determinants of CAD. Furthermore, combined C1q and hsCRP level showed higher discriminatory accuracy in predicting CAD than C1q (AUC: 0.676 vs 0.585, P = 0.101; NRI: 10.4%, P = 0.049; IDI: 3.9%, P < 0.001) or hsCRP (AUC: 0.676 vs 0.585, P = 0.101; NRI: 16.7%, P = 0.006; IDI: 5.8%, P < 0.001).ConclusionsReduced serum C1q and increased hsCRP are independently associated with CAD and could be potential predictors for CAD diagnosis. Furthermore, combined C1q and hsCRP showed better performance in predicting CAD than using single one.     

Predicting factors of postoperative relapse in T2-4N0M0 colorectal cancer patients via harvesting a minimum of 12 lymph nodes

Background and aim  The aim of this retrospective study was to determine which clinicopathological factors influenced the incidence of postoperative relapse and overall survival rates after radical resection of T_2-4N₀M₀ colorectal cancer (CRC) patients via harvesting a minimum of 12 lymph nodes. Materials and methods  Between January 2001 and June 2006, a total of 342 T_2-4N₀M₀ CRC patients who underwent radical resection were retrospectively analyzed in Kaohsiung Medical University Hospital. Of these 342 patients, 155 were observed by harvesting a minimum of 12 lymph nodes. These 155 patients were followed up intensively, and their outcomes were investigated retrospectively. Results  Of 155 patients, 83 were men (53.5%) and 72 (46.5%) were women. The mean age was 65.5 ± 11.1 years (range, 24–89 years). The median follow-up period was 49 months (range, 19–80 months). The present data showed invasive depth (P = 0.012), vascular invasion (P < 0.001), and perineural invasion (P = 0.009) as significantly prognostic factors for postoperative 5-year relapse rate by Kaplan–Meier analysis. Likewise, invasive depth (P = 0.013), vascular invasion (P < 0.001), and perineural invasion (P = 0.008) were significant factors for postoperative 5-year survival rate. Meanwhile, using a Cox proportional hazards analysis, depth of tumor invasion (P = 0.026) and vascular invasion (P = 0.001) were the independent predictors for postoperative relapse. Furthermore, the presence of vascular invasion was considerably correlated to the higher postoperative relapse rate and the poorer overall survival rates by survival analyses (P < 0.0001). Conclusions  Besides the conventional depth of tumor invasion, this study highlights the potential for using vascular invasion as a means of identifying a subgroup of T_2-4N₀M₀ CRC patients with adequate lymph node harvest at higher risk who would potential benefit from adjuvant therapy after surgery.     

结直肠癌术后肠梗阻的危险因素分析及预测模型建立

目的 构建结直肠癌(CRC)术后肠梗阻(POI)的列线图风险预测模型并进行验证.方法 回顾性收集2018年6月至2019年8月接受CRC手术患者413例的围术期临床资料,年龄≥18岁,ASAⅠ—Ⅲ级.通过LASSO回归和多因素Logistic回归分析筛选独立危险因素,以此建立列线图模型.通过C?index验证模型的区分...     

蚊虫密度的气象影响因素分析

目的 探讨山西省运城市某流行性乙型脑炎(乙脑)高发县蚊虫密度与气象因素之间的关系,筛选适合因子预测蚊虫密度变化趋势.方法 监测2007-2009年5-10月运城市某县蚊虫密度并收集同期气象资料,气象数据经膨化处理,用SPSS17.0软件分析两者相关性,并用逐步回归分析建立蚊虫密度的气象因子拟合模型.结果 蚊虫季节消长曲线为单峰型,5月出现,8月达高峰,10月消亡.蚊虫密度与月平均温度、月平均气压等相关,与月日照、相对湿度无关.逐步回归分析得出蚊虫密度的气压回归方程,ap02(当月及前2个月的平均气压)和ap1(提前1个月的平均气压)有良好的拟合效果,两者相比ap1具有更好的实际操作性.结论 气象因素对蚊虫密度有重要影响,可以利用气压拟合模型预测蚊虫密度变化趋势.     

血清肿瘤标志物CA15-3对Her-2阳性乳腺癌术后化疗疗效的评估价值

目的探讨糖类抗原CA15—3在Her-2过表达乳腺癌患者术后化疗疗效监测的评估价值。方法回顾性分析66例Her-2阳性乳腺癌患者术后以蒽环类及紫杉类（44例采用Herceptin生物化疗）为基础化疗过程中血清CA15-3的变化。根据2000年RECIST标准分有效组（OR组）及无效组（NR组）,通过分析两组治疗前后血清CA15-3变化及治疗前后CA15-3下降比率绘制ROC曲线特征评估其对化疗疗效的价值。结果与治疗前相比,所有患者治疗后CA15-3血清水平显著下降（P〈0．05）,治疗前有效组及无效组间CA15-3血清水平无明显差异（P〉0．05）,有效组治疗前后CA15-3血清水平与化疗相关,治疗前后有显著差异（P〈0．05）,而无效组治疗前后与化疗无相关,治疗前后无显著差异（P〉0．05）,治疗前后CA15—3下降比率绘制ROC曲线,其曲线下面积为O．527。采用Herceptin的生物化疗患者,与治疗前相比治疗后CA15—3血清水平亦显著下降（P〈0．05）,治疗前有效组及无效组间CA15-3血清水平亦无明显差异（P〉0．05）,有效组治疗前后CA15—3血清水平与化疗相关,治疗前后有显著性差异（P〈0．05）,而无效组治疗前后血清CA15-3水平与化疗相关（P〈0．05）,但无显著性差异（P〉0．05）。采用治疗前后CA15-3下降比率绘制ROC曲线,其曲线下面积为O．618。结论CAl5-3在Her-2阳性乳腺癌患者术后化疗疗效有一定预测作用,在Herceptin为基础的生物化疗中有一定的敏感性及特异性。     

改良早期预警评分系统在预测急诊抢救室患者病情中的应用研究

目的探讨改良早期预警评分系统（MEWS）在急诊抢救室的应用价值。方法对2012年4月-5月在急诊抢救室就诊的213例患者进行MEWS评分,分析不同分数段患者的分布特点,追踪患者人院后的去向、病情转归及收住专科病房和重症医学科（ICU/CCU）的时间。结果与MEWS得分≥5分的患者相比,MEWS得分〈5分者好转出院、转入专科病房的比例较高,转入ICU/CCU比例低,差异有统计学意义（P〈0．05）;不同MEWS评分段患者转入ICU／CCU的时间最短,其次是出院回家,转入专科病房的时间最长,但MEWS得分〈5分者与≥5分者出院、转入专科病房和ICU／CCU时间之间的差异无统计学意义（P〉0．05）。结论MEWS可以预测患者病情变化及严重程度,对医护人员及时采取救护措施、合理安排住院有一定的指导作用,值得推广应用。